Provider Demographics
NPI:1003425695
Name:BESTCARE NURSING AND RESIDENTIAL DAY PROGRAM
Entity Type:Organization
Organization Name:BESTCARE NURSING AND RESIDENTIAL DAY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KOLAWOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-677-5135
Mailing Address - Street 1:105 EVESBORO MEDFORD RD STE F
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3865
Mailing Address - Country:US
Mailing Address - Phone:856-446-2139
Mailing Address - Fax:856-988-1094
Practice Address - Street 1:105 EVESBORO MEDFORD RD STE F
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3865
Practice Address - Country:US
Practice Address - Phone:856-446-2139
Practice Address - Fax:856-988-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5080600Medicaid